HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kreft, B. Articles by Schild, H. H. Search for Related Content PubMed PubMed Citation Articles by Kreft, B. Articles by Schild, H. H.

Detection of Thrombosis in the Portal Venous System: Comparison of Contrast-enhanced MR Angiography with Intraarterial Digital Subtraction Angiography¹

¹ From the Departments of Radiology (B.K., H.S., S.F., R.C., J.G., D.P., R.B., H.H.S.) and Surgery (M.W., A.H.), University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. Received July 19, 1999; revision requested August 30; revision received October 5; accepted October 26. Address correspondence to B.K. (e-mail: kreft@mailer.meb.uni-bonn.de).

View larger version (93K): [in a new window]   Figure 1a. Images obtained in a 21-year-old woman with a history of recurrent esophageal bleeding who was suspected to have portal vein thrombosis with cavernous transformation on the basis of color Doppler US findings. (a) Selective coronal MIP image from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle) and (b) anteroposterior intraarterial DSA splenoportographic image. Both a and b show a right portal vein thrombosis (solid arrow) with collateral vessels (arrowheads) lateral to the patent main portal vein. The signal intensity differences within the portal venous system in a are caused by less contrast medium concentration in the splenic vein (large open arrow in a) than in the superior mesenteric vein (small open arrow in a) because of pooling of contrast medium within the spleen. The intraluminal flow artifacts were not seen on the late hepatic vein images (not shown) and could therefore be differentiated from a luminal thrombus.

View larger version (153K): [in a new window]   Figure 1b. Images obtained in a 21-year-old woman with a history of recurrent esophageal bleeding who was suspected to have portal vein thrombosis with cavernous transformation on the basis of color Doppler US findings. (a) Selective coronal MIP image from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle) and (b) anteroposterior intraarterial DSA splenoportographic image. Both a and b show a right portal vein thrombosis (solid arrow) with collateral vessels (arrowheads) lateral to the patent main portal vein. The signal intensity differences within the portal venous system in a are caused by less contrast medium concentration in the splenic vein (large open arrow in a) than in the superior mesenteric vein (small open arrow in a) because of pooling of contrast medium within the spleen. The intraluminal flow artifacts were not seen on the late hepatic vein images (not shown) and could therefore be differentiated from a luminal thrombus.

View larger version (108K): [in a new window]   Figure 2a. Images obtained in a 30-year-old man with alcohol-induced hepatic cirrhosis who was suspected to have acute portal vein thrombosis on the basis of color Doppler US findings. (a) Coronal MIP image from the portal venous phase of contrast-enhanced three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) transverse T1-weighted gradient-echo MR image (220/4.5, 100° flip angle) obtained after gadopentetate dimeglumine administration, and (d) anteroposterior intraarterial DSA splenoportographic image. In a and b, the thrombosis (arrow) of the main portal vein is clearly seen; however, the extent of the thrombosis is better appreciated in b because of the signal void. The thrombus (arrow in c) is also clearly seen in c. In a, there is prolonged contrast medium enhancement of the hepatic artery (arrowhead), which was confirmed on the hepatic arterial phase image (not shown). d also shows complete thrombosis of the portal vein and a splenic vein up to a point just proximal to the portal confluence (solid arrow). The inferior mesenteric vein filling is retrograde (small open arrow), and gastroesophageal varices are filled (large open arrow). In comparison with the angiographic images, the MR images show the whole portal venous system better. The portal vein thrombosis was surgically verified during liver transplantation.

View larger version (115K): [in a new window]   Figure 2b. Images obtained in a 30-year-old man with alcohol-induced hepatic cirrhosis who was suspected to have acute portal vein thrombosis on the basis of color Doppler US findings. (a) Coronal MIP image from the portal venous phase of contrast-enhanced three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) transverse T1-weighted gradient-echo MR image (220/4.5, 100° flip angle) obtained after gadopentetate dimeglumine administration, and (d) anteroposterior intraarterial DSA splenoportographic image. In a and b, the thrombosis (arrow) of the main portal vein is clearly seen; however, the extent of the thrombosis is better appreciated in b because of the signal void. The thrombus (arrow in c) is also clearly seen in c. In a, there is prolonged contrast medium enhancement of the hepatic artery (arrowhead), which was confirmed on the hepatic arterial phase image (not shown). d also shows complete thrombosis of the portal vein and a splenic vein up to a point just proximal to the portal confluence (solid arrow). The inferior mesenteric vein filling is retrograde (small open arrow), and gastroesophageal varices are filled (large open arrow). In comparison with the angiographic images, the MR images show the whole portal venous system better. The portal vein thrombosis was surgically verified during liver transplantation.

View larger version (129K): [in a new window]   Figure 2c. Images obtained in a 30-year-old man with alcohol-induced hepatic cirrhosis who was suspected to have acute portal vein thrombosis on the basis of color Doppler US findings. (a) Coronal MIP image from the portal venous phase of contrast-enhanced three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) transverse T1-weighted gradient-echo MR image (220/4.5, 100° flip angle) obtained after gadopentetate dimeglumine administration, and (d) anteroposterior intraarterial DSA splenoportographic image. In a and b, the thrombosis (arrow) of the main portal vein is clearly seen; however, the extent of the thrombosis is better appreciated in b because of the signal void. The thrombus (arrow in c) is also clearly seen in c. In a, there is prolonged contrast medium enhancement of the hepatic artery (arrowhead), which was confirmed on the hepatic arterial phase image (not shown). d also shows complete thrombosis of the portal vein and a splenic vein up to a point just proximal to the portal confluence (solid arrow). The inferior mesenteric vein filling is retrograde (small open arrow), and gastroesophageal varices are filled (large open arrow). In comparison with the angiographic images, the MR images show the whole portal venous system better. The portal vein thrombosis was surgically verified during liver transplantation.

View larger version (100K): [in a new window]   Figure 2d. Images obtained in a 30-year-old man with alcohol-induced hepatic cirrhosis who was suspected to have acute portal vein thrombosis on the basis of color Doppler US findings. (a) Coronal MIP image from the portal venous phase of contrast-enhanced three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) transverse T1-weighted gradient-echo MR image (220/4.5, 100° flip angle) obtained after gadopentetate dimeglumine administration, and (d) anteroposterior intraarterial DSA splenoportographic image. In a and b, the thrombosis (arrow) of the main portal vein is clearly seen; however, the extent of the thrombosis is better appreciated in b because of the signal void. The thrombus (arrow in c) is also clearly seen in c. In a, there is prolonged contrast medium enhancement of the hepatic artery (arrowhead), which was confirmed on the hepatic arterial phase image (not shown). d also shows complete thrombosis of the portal vein and a splenic vein up to a point just proximal to the portal confluence (solid arrow). The inferior mesenteric vein filling is retrograde (small open arrow), and gastroesophageal varices are filled (large open arrow). In comparison with the angiographic images, the MR images show the whole portal venous system better. The portal vein thrombosis was surgically verified during liver transplantation.

View larger version (124K): [in a new window]   Figure 3a. Images obtained in a 49-year-old man with hepatitis C-induced liver cirrhosis who was suspected to have complete thrombosis of the portal vein on the basis of color Doppler US findings. (a) Coronal MIP image and (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) anteroposterior intraarterial DSA splenoportographic image, and (d) anteroposterior intraarterial DSA mesentericoportographic image. a and b correctly show partial thrombosis of the portal (1), splenic (2), and superior mesenteric (3) veins (arrows in a); however, partial nonocclusive thrombus of the proximal portal vein (arrow in b) is best appreciated in b. In c and d, complete thrombosis of the portal vein is diagnosed, because the remainder of the perfused lumen of the portal vein (arrow in c) is thought to be a collateral vessel. Note in d that there is retrograde flow in the inferior mesenteric vein (large arrow) and reversed flow from the superior mesenteric to the splenic (small arrow) vein, which cannot be seen in a and b; however, partial thrombosis of the splenic and superior mesenteric veins are better visualized in a and b.

View larger version (120K): [in a new window]   Figure 3b. Images obtained in a 49-year-old man with hepatitis C-induced liver cirrhosis who was suspected to have complete thrombosis of the portal vein on the basis of color Doppler US findings. (a) Coronal MIP image and (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) anteroposterior intraarterial DSA splenoportographic image, and (d) anteroposterior intraarterial DSA mesentericoportographic image. a and b correctly show partial thrombosis of the portal (1), splenic (2), and superior mesenteric (3) veins (arrows in a); however, partial nonocclusive thrombus of the proximal portal vein (arrow in b) is best appreciated in b. In c and d, complete thrombosis of the portal vein is diagnosed, because the remainder of the perfused lumen of the portal vein (arrow in c) is thought to be a collateral vessel. Note in d that there is retrograde flow in the inferior mesenteric vein (large arrow) and reversed flow from the superior mesenteric to the splenic (small arrow) vein, which cannot be seen in a and b; however, partial thrombosis of the splenic and superior mesenteric veins are better visualized in a and b.

View larger version (153K): [in a new window]   Figure 3c. Images obtained in a 49-year-old man with hepatitis C-induced liver cirrhosis who was suspected to have complete thrombosis of the portal vein on the basis of color Doppler US findings. (a) Coronal MIP image and (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) anteroposterior intraarterial DSA splenoportographic image, and (d) anteroposterior intraarterial DSA mesentericoportographic image. a and b correctly show partial thrombosis of the portal (1), splenic (2), and superior mesenteric (3) veins (arrows in a); however, partial nonocclusive thrombus of the proximal portal vein (arrow in b) is best appreciated in b. In c and d, complete thrombosis of the portal vein is diagnosed, because the remainder of the perfused lumen of the portal vein (arrow in c) is thought to be a collateral vessel. Note in d that there is retrograde flow in the inferior mesenteric vein (large arrow) and reversed flow from the superior mesenteric to the splenic (small arrow) vein, which cannot be seen in a and b; however, partial thrombosis of the splenic and superior mesenteric veins are better visualized in a and b.

View larger version (178K): [in a new window]   Figure 3d. Images obtained in a 49-year-old man with hepatitis C-induced liver cirrhosis who was suspected to have complete thrombosis of the portal vein on the basis of color Doppler US findings. (a) Coronal MIP image and (b) coronal single section from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (c) anteroposterior intraarterial DSA splenoportographic image, and (d) anteroposterior intraarterial DSA mesentericoportographic image. a and b correctly show partial thrombosis of the portal (1), splenic (2), and superior mesenteric (3) veins (arrows in a); however, partial nonocclusive thrombus of the proximal portal vein (arrow in b) is best appreciated in b. In c and d, complete thrombosis of the portal vein is diagnosed, because the remainder of the perfused lumen of the portal vein (arrow in c) is thought to be a collateral vessel. Note in d that there is retrograde flow in the inferior mesenteric vein (large arrow) and reversed flow from the superior mesenteric to the splenic (small arrow) vein, which cannot be seen in a and b; however, partial thrombosis of the splenic and superior mesenteric veins are better visualized in a and b.

View larger version (130K): [in a new window]   Figure 4a. Images obtained in a 59-year-old woman with a history of duodenal variceal bleeding. (a) Coronal MIP image from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) transverse respiratory-triggered T2-weighted turbo spin-echo MR image (2,800/80), and (c) anteroposterior intraarterial DSA splenoportographic image. In a, and on the single-section images (not shown), there is an area of decreased signal intensity (arrow) in the midportion of the portal vein, which was falsely thought to represent partial nonocclusive thrombus. In b, the diagnosis was further supported by a rim of increased signal intensity (arrow) in the ventral part of the portal vein. However, color Doppler US and intraarterial DSA (c) did show a normal main portal vein (solid arrow in c) and splenic vein (open arrow in c) and no evidence of partial portal vein thrombosis. The decreased-signal-intensity area within the portal vein in a was probably caused by a susceptibility artifact from adjacent bowel gas, whereas the rim of increased signal intensity in b was most probably caused by slow-flowing blood. Note the duodenal varices (arrowhead in a), which were seen only with contrast-enhanced MR angiography.

View larger version (140K): [in a new window]   Figure 4b. Images obtained in a 59-year-old woman with a history of duodenal variceal bleeding. (a) Coronal MIP image from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) transverse respiratory-triggered T2-weighted turbo spin-echo MR image (2,800/80), and (c) anteroposterior intraarterial DSA splenoportographic image. In a, and on the single-section images (not shown), there is an area of decreased signal intensity (arrow) in the midportion of the portal vein, which was falsely thought to represent partial nonocclusive thrombus. In b, the diagnosis was further supported by a rim of increased signal intensity (arrow) in the ventral part of the portal vein. However, color Doppler US and intraarterial DSA (c) did show a normal main portal vein (solid arrow in c) and splenic vein (open arrow in c) and no evidence of partial portal vein thrombosis. The decreased-signal-intensity area within the portal vein in a was probably caused by a susceptibility artifact from adjacent bowel gas, whereas the rim of increased signal intensity in b was most probably caused by slow-flowing blood. Note the duodenal varices (arrowhead in a), which were seen only with contrast-enhanced MR angiography.

View larger version (145K): [in a new window]   Figure 4c. Images obtained in a 59-year-old woman with a history of duodenal variceal bleeding. (a) Coronal MIP image from the portal venous phase of contrast-enhanced dynamic three-dimensional T1-weighted fast-field-echo MR angiography (4.7/1.4, 40° flip angle), (b) transverse respiratory-triggered T2-weighted turbo spin-echo MR image (2,800/80), and (c) anteroposterior intraarterial DSA splenoportographic image. In a, and on the single-section images (not shown), there is an area of decreased signal intensity (arrow) in the midportion of the portal vein, which was falsely thought to represent partial nonocclusive thrombus. In b, the diagnosis was further supported by a rim of increased signal intensity (arrow) in the ventral part of the portal vein. However, color Doppler US and intraarterial DSA (c) did show a normal main portal vein (solid arrow in c) and splenic vein (open arrow in c) and no evidence of partial portal vein thrombosis. The decreased-signal-intensity area within the portal vein in a was probably caused by a susceptibility artifact from adjacent bowel gas, whereas the rim of increased signal intensity in b was most probably caused by slow-flowing blood. Note the duodenal varices (arrowhead in a), which were seen only with contrast-enhanced MR angiography.